Fillers (Fill - from English. Fill) - this injection skin fillers, which are used in cosmetology for smoothing small, medium and deep wrinkles, reducing the depth of nasolabial folds, as well as the correction of atrophic scars. But fillers in cosmetology are used not only for this. With their help, you can add additional volume to the cheekbones and cheeks, as well as increase the volume of the lips or make the outline of their red border similar to Cupid's bow.
Not possessing special knowledge, it is very difficult to choose a filler against the background of their great diversity. We will explain this by the example of such a simple and understandable criterion as the percentage of hyaluronic acid (HA). Usually in fillers its content ranges from 18.5 to 26 mg / cm.3, and it would seem that everything is simple - the longer it is, the longer the effect will last. But this rule only works when you compare the line of fillers of a single manufacturer to each other.
But this does not work when compared with, for example, Restylane fillers.® and juvederm®containing 20 and 24 mg / cm3, respectively. The fact is that the duration of the effect will be more influenced by the type of chemical modification of the HA, during which its single chains are “stitched” together. Manufacturers use different technologies for the "crosslinking" of HA molecules, which leads to the formation of different types of bonds between its individual chains and a different number of such bonds, which directly affects the rate of destruction of the filler.
Fillers in cosmetology: what it is, photo
In 1940-1950, silicone was used as a filler for cosmetic procedures, but in many patients the body reacted to silicone as a foreign body, which led to the development of granulomas at the site of its introduction. Therefore, he was soon banned. Since the 1970s, collagen injections were actively used in cosmetology as fillers, and in 1995 the first fillers made of hyaluronic acid appeared. To date, 5 main types of fillers are used in cosmetology.
Fillers in cosmetology for the face: types
- collagen based fillers,
- hyaluronic acid fillers,
- based on poly-L-lactic acid,
- based on calcium hydroxyapatite,
- based on polymethyl methacrylate microspheres.
Now the most popular are fillers of hyaluronic acid. They are easy to use, effectively eliminate wrinkles and folds, give additional volume. However, the duration of their effect (depending on the brand of the drug) - an average of 6 months, and only some of them retain the effect up to 12 months. In turn, the fillers of poly-L-lactic acid or calcium hydroxyapatite - the effect lasts up to 18-24 months, but working with these drugs requires a lot of experience and special training of the doctor.
And that is why such a filler as “Sculptra”, which is essentially a full-fledged replacement for plastic surgery, is practically not used in Russia (a complex technique of application and the need for special training abroad). There is also a drug "Artefill" from polymethyl-methacrylate microspheres, the guaranteed effect after which lasts up to 10 years, but it is too expensive and does not apply in Russia. Below you can read about the features of the application of all types of fillers and their comparative characteristics.
Fillers for eyes, lips, fillers in nasogubki: photos before and after
Fillers: what is this procedure, technique
Fillers are inserted into the superficial, middle or deep layers of the skin using a syringe with a very thin needle (usually labeled 27-30G). The depth of the introduction of fillers directly depends on the depth of wrinkles. The thinner the needle, the less painful the procedure will be and the lower the risk of hematomas after the procedure. However, with the help of the thinnest needles, you can enter only soft fillers designed for superficial wrinkles and the lip area.
For the correction of medium and deep wrinkles and folds, denser fillers are used, requiring a slightly larger needle diameter. Dense fillers dissolve more slowly than soft ones, but their administration is more painful. Some fillers already contain lidocaine anesthetic (usually 0.3%), or the doctor may do regional anesthesia. The procedure usually takes from 15 to 30 minutes.
If we are talking about the correction of wrinkles, then fillers are introduced into the base of each wrinkle using a syringe (Fig. 8). Thus, a filler depot is created under the wrinkle, which kind of pushes the fabric out, smoothing the wrinkle or fold. If it is necessary to add additional volume to the cheeks or cheekbones, then a filler is inserted into the skin evenly throughout the entire area.
Correction of deep wrinkles with filler -
The effect of most fillers is noticeable immediately after the procedure. Some fillers (of those made on the basis of hyaluronic acid) are not fully hydrated. This means that after being introduced into the tissues, they will absorb water a little more within 24 hours, expanding further. Thus, the final result - you will see only a day after the introduction. Whether the filler is fully hydrated or not is very important when you pick up lip fillers.
The result of the introduction of some fillers (such as "Sculptra") - appears only after 3-4 weeks, but this is one of the few drugs that works not due to the mechanical filling of the tissue with gel, but due to the formation of new collagen. Radiess has a similar effect, but the price in cosmetology is always very high for such fillers. Detailed information about them you will find below.
What is fillers in cosmetology for the face: video procedures
Collagen Fillers -
Collagen is the main part of the dermal layer of the skin (dermis). The volume of collagen in the skin is 70% of its dry mass, and it is precisely because of this protein that the skin has strength and elasticity. A total of 11 different types of collagen are found in the skin, but mostly collagen types I and III. For the production of fillers manufacturers use collagen of the same types, but its origin may be different. It may be bovine, porcine, or bioengineered human collagen.
Collagen fillers have been used since 1981. The first fillers were made of bovine collagen (drugs Zyderm 1, Zyderm 2 and Zyplast®). In the production of modern collagen fillers, the achievements of genetic engineering or innovative Israeli technology Glymatrix are used.®, which allows you to start the process of formation of new collagen in tissues, as well as extends the effect up to 12 months. Nevertheless, it should be noted that collagen injections of fillers with collagen are very rare in Russia (unlike in Europe and the USA).
1) CosmoDerm fillers® and CosmoPlast® -
Fillers of this type include CosmoDerm 1, CosmoDerm 2 and CosmoPlast®. They are produced by the innovative American company Allergan Inc., which by the way is also the manufacturer of Botox®. Bioengineering human collagen is used in the production of these fillers, which is obtained by cultivating fibroblasts under laboratory conditions. Fibroblasts produce collagen, which is then used in the production of these fillers.
CosmoDerm 1 contains 35 mg / cm3 bioengineered human collagen and 0.3% lidocaine solution. This filler is most often used to remove superficial wrinkles and scars, for example, wrinkles around the eyes or wrinkles of smokers around the lips. In CosmoDerm 2, the amount of collagen will be 2 times larger, and this filler is more often used to eliminate post-acne scars. CosmoPlast also contains 35 mg / cm3 collagen, but due to the use of glutaraldehyde - this drug undergoes a slower breakdown than the first two.
Therefore, CosmoPlast is used to remove deeper wrinkles and atrophic scars, often very often in combination with hyaluronic acid fillers. In this case, due to the filler with collagen, a bulk tissue is created, after which a more superficial injection of the filler with hyaluronic acid is performed in the same area. The advantages of CosmoDerm and CosmoPlast are that they do not require skin tests, they give less swelling and hemorrhages compared with hyaluronic acid injections. Disadvantages - high price, duration of 3 and 4 months, respectively.
2) Evolens Fillers (Evolense®)-
Evolencie filler is the most innovative collagen filler that is just getting spread. Today it is used in Europe, Israel and the United States. Producer - the company "Colbar Laboratories", Israel. The drug contains porcine collagen 1 and 3 types in the amount of 35 mg / cm3. A number of state-of-the-art technologies are used in the production of the drug, which make it possible to make porcine collagen completely immunologically compatible with human collagen, but the most important thing is Glymatrix technology®.
This technology allows you to associate collagen with polysaccharide D-ribose, which gives the collagen a certain three-dimensional structure, which is preserved after the introduction of the drug into the tissue. Such a three-dimensional framework is used by the patient's skin fibroblasts to produce their own collagen, triggering the processes of neocollagenogenesis and neovascularization. At the same time, the activity of fibroblasts producing new collagen increases noticeably in the skin.
There are 2 forms of release of this filler - Evolens® and evolens® Breeze. The first is used to correct deep wrinkles and folds on the face, and can be found in the middle and deep layers of the skin. The second has a less fibrous consistency and is used to remove fine wrinkles, to change the contour of the red border of the lips, as well as the shape of the body of the lips. Clinical studies conducted by Rzany, Monstrey and co-authors (involving a total of 740 people) showed that the effect after Evolenсe lasts at least 12 months, and in some patients lasted up to 18 months.
Evolense filler injections® -
Hyaluronic Acid Fillers -
Hyaluronic acid fillers are most often used to eliminate cosmetic defects. They are easy to use, do not require too complex training of the doctor. Hyaluronic acid is a polysaccharide that is constantly synthesized by skin cells. Its biological role is to moisturize the skin and make the skin volume, which is possible due to the fact that its molecules are able to hold a volume of water - 1000 times the volume of the polysaccharide molecules.
The "lifetime" of hyaluronic acid molecules in the body is no more than 24-48 hours, which is why the so-called "bound hyaluronic acid" is used for the production of fillers. It is a gel in which single molecules of hyaluronic acid are connected to each other (with the help of special substances) in long chains, which prevents its rapid destruction. After the introduction of such a gel into the tissue for a long time, it retains the elastic structure and volume, and this makes it possible to use it for the correction of wrinkles and to give volume to the tissues of the face. The duration of the effect is usually about 6 months, but for a number of drugs the effect lasts up to 9-12 months.
Type of hyaluronic acid filler -
Below we list the most popular hyaluronic acid fillers, but in general there are a very large number of them, and they all have different properties. For example, one of the most important characteristics of a filler is its elasticity (density). High density fillers are used to eliminate deep wrinkles and folds. Slightly less dense - designed to create volume in the cheekbones and cheeks, and very soft - used in the lips and eyes. In Table 1 - you will find information on trademarks of fillers and for working in which areas of the person they are recommended.
1) Filler Restylane® (Restylane) -
Restylane contains non-animal hyaluronic acid obtained by bacterial fermentation. The manufacturer is the company Q-Med (Sweden). This is the most popular filler in the United States (FDA approved in 2003). It has a high concentration of hyaluronic acid - 20 mg per 1 ml. Restylane refers to non-fully hydrated gels, i.e. during the first 24 hours after the injection, it will absorb moisture, which will lead to additional expansion of the soft tissues at the injection site.
Due to the fact that the gel has an average density and elasticity (gel viscosity corresponds to 100,000 particles per 1 ml), it is well suited for the correction of wrinkles of medium depth. The effect after its introduction remains from 6, but no more than 8 months. This drug is ideal for reducing the depth of the nasolabial folds, wrinkles "puppet" in the corners of the mouth, nose defects, acne scars, as well as for lifting the tip of the nose.
In addition to the classic Restylane filler® there are also several options that are more adapted to specific tasks: 1) "Restylane Touch" - to remove the smallest wrinkles, 2) "Restylane Lip" - to correct the volume of the lips, 3) "Restylane Sub-Q" - to create additional volume in cheekbones and cheeks. All of these drugs contain the same concentration of hyaluronic acid, and differ only in the density / elasticity of the gel. The cost of 1 syringe with a volume of 1 ml for clinics - from 6,000 rubles, which in our opinion makes this filler the best in terms of price / quality ratio. In clinics, the price starts from 10 000 rubles.
A big plus to the Restylane brand fillers is that the manufacturer company checks its fillers for residual bacterial proteins. This is important because almost all fillers are now produced by the method of bacterial fermentation, and residual proteins can cause the risk of allergic reactions. For example, the popular Yuviderm fillers do not undergo similar laboratory tests. However, in the literature there are no comparative data on the frequency of allergic reactions of fillers of different brands.
→ Restylane filler release forms®
2) Filler Perlane® (Perline) -
Filler Perline is also developed by Q-Med (Sweden). It is part of the Restylane line of fillers.®, differing from them in higher viscosity and density of the gel. The concentration of hyaluronic acid in it is the same - 20 mg per 1 ml. This filler is approved by the FDA and is intended to remove only pronounced deep wrinkles and skin folds. The duration of the effect is about 9 months after the injection (sometimes longer).
This gel is an excellent option to reduce the severity of nasolabial folds, to increase the volume of cheekbones, reduce deep wrinkles on the chin, wrinkles "puppet" in the corners of the mouth. In general, for a successful work with this drug, the doctor must have extensive experience in using fillers, since Perline has a very high density. The use of such a gel with insufficient experience can lead to the fact that the surface of the skin will be uneven (bumpy). The cost price of 1 syringe with a volume of 1 ml is about 7,000 rubles, and in clinics the cost usually starts from 12,000 rubles.
3) Juvederm filler® (Yuviderm) -
Yuviderm is one of the most popular fillers in Europe and the USA. Manufacturer - Allergan Inc. (USA). Contains hyaluronic acid, obtained using bacterial fermentation technology. The gel is not fully hydrated, so we should expect additional expansion in the first 24 hours after injection. Two forms of Juvederm filler® were approved by the FDA in 2006 - this is "Juvederm Ultra" and "Juvederm Ultra Plus". They correspond to those released for Russia - "Yuviderm Ultra 3" and "Yuviderm Ultra 4".
In Yuviderm Ultra 3 and Yuviderm Ultra 4, the concentration of hyaluronic acid is the same - 24 mg / 1 ml, but they differ from each other in the density of the gel. Gel "Yuviderm Ultra 4" - the most dense, and is used for the correction of deep wrinkles and folds, as well as atrophic scars. Slightly less dense "Yuviderm Ultra 3" - used for the correction of medium-depth wrinkles, but also suitable for working with the contour of the red border of the lips. Moreover, both of these gels are equally suitable for increasing the volume of the cheekbones, reducing the depth of the nasolabial folds, as well as for wrinkles of the "puppet".
The cost price of 1 syringe with a volume of 1 ml (depending on the form of release) - ranges from 7,000 to 13,000 rubles, and accordingly in clinics the price will start from 12,000 rubles for the most inexpensive option - Juvederm Ultra 2, used for lips and wrinkles around the eyes . The duration of the "Yuviderm Ultra 3" effect is similar to the Restylane filler.® and is 6-9 months, but the effect of "Yuviderm Ultra 4" - will last up to 12 months. Additionally, there are 5 more variants of this filler, designed for narrow applications (you can read them at the link below). These include -
- Juvederm Ultra 2,
- Juvederm Volma,
- Juvederm Ultra Smile,
- Juvederm Volbella (Volbella),
- Juvederm Volift (Volift).
→ Forms of release of Juvederm filler®
4) Filler Belotero (Belotero) -
Filler Belotero was created by the Swiss company Anteis S.A., but at the moment the owner of the brand is the pharmaceutical company Merz (Germany). Belotero is positioned as a "smart filler", which has a unique degree of uniformity and ability to be evenly distributed in the tissues. This ensures that you will not feel it in the skin. Has FDA approval. The line of this filler is represented by 3 drugs - Belotero Soft, Belotero Balance and Belotero Intens.
Belotero Soft - contains 20 mg / ml3 hyaluronic acid, and is intended for the correction of fine surface wrinkles, as well as delicate areas of the face, neck and décolleté, which have thin skin. Belotero Balance - contains 22.5 mg / ml3 hyaluronic acid, and is used to correct medium wrinkles and folds, as well as lip augmentation. And the third option - Belotero Intens - with 22.5 mg / ml3 гиалуроновой кислоты, для коррекции глубоких морщин и складок, а также увеличения объема скул и щек. Эффект держится примерно 6-9 месяцев. Себестоимость 1 шприца объемом 1 мл - около 6000 рублей.
→ Стоимость в клиниках - от 11 000 рублей за 1 мл.
5) Филлер Стилаж (Stylage) -
Филлер Stylage® выпускается французской компанией VIVACY Laboratories. Style filler has a whole line of drugs. First, it is a line of 3 Stylage fillers.® - With letter designations S, M and L. They are intended for fine superficial, medium and deep wrinkles, respectively. Stylage effect® S lasts up to 9 months, and M and L - up to 12 months. Each version of the gel is available with and without lidocaine.
The second option is a soft filler Stylage Lips, which contains 18.5 mg / ml3 hyaluronic acid and is intended only to increase the volume of the body of the lips and / or contouring their red border. The effect lasts for about 6 months, sometimes longer. Well, the third option is Stylage XL and XXL fillers, which are designed to add volume to the cheekbones and cheeks. The effect persists for about 12 months.
The manufacturer as one of the competitive advantages claims the content of antioxidants (mannitol and sorbitol), which slow down the destruction of the hyaluronic acid gel. However, the process of destruction of hyaluronic acid gels in tissues depends on many factors, and antioxidants are far from the main ones. Comparative research on this issue with other fillers - the manufacturer does not publish. Cost Stylage® S, M, L is about 3500-4000 rubles (per 1 syringe). The cost price of the other forms is about 5,500 rubles per 1 syringe 1.0 ml. In proportion this can be calculated and the price in clinics (usually + 5000 rubles to the cost of the drug).
6) Princess fillers® and hyalax® -
Both Princess Filler and Filler Gialax are produced by the same company Croma-Pharma (Austria). In the printers fillers lineup there are 2 forms of release. The first option is the classic Princess Filler®This is a fairly soft filler that can be used for superficial and medium wrinkles, as well as for lip augmentation. For the correction of deep wrinkles and nasolabial folds, increasing the volume of the cheekbones and cheeks, you can use a more dense version of this drug - Princess Volume (Princess Volyuma).
The effect of the classic Princess Filler will last 4-6 months. The effect of the second second variant of the filler will last up to 6-9 months. It must be said that this brand is the cheapest among fillers. Cosmetic clinics buy them - only 3000 and 3500 rubles, respectively (for a syringe 1.0 ml), and the low price allows you to make a higher margin. For comparison, the purchase price of 1 syringe 1.0 ml Yuviderm Ultra 3 is about 11,000 rubles.
It should be noted that for Princess fillers (in comparison with the above) - very few clinical studies have been published, and not too many people have participated in them. However, if you want to save money or get acquainted with the procedure of contour plastics for the first time, you can easily choose this trademark. By the way, another economy option - the line of fillers "Revofil" (Fine, Plus and Ultra), Korean production. Their purchase price for a 1.0 ml syringe is also only about 3100 rubles.
Radiesse filler (based on calcium hydroxyapatite) -
The most popular filler of this type is Radiesse. The drug was developed by the well-known American biotechnology company BioForm Medical, but at the moment the drug belongs to the German company Merz Pharma. Has FDA approval. The preparation consists of microspherical particles (25-45 microns in size) of 30% calcium hydroxyapatite, which are suspended in a gel-like carrier.
The gel carrier filler dissolves approximately 2-3 months after the injection, after which the skin cells are in direct contact with the microspheres. Clinical studies have shown that the gradual destruction of microspheres by macrophages leads to the activation of the function of fibroblasts and the replacement of this volume with new formed collagen (according to Hirsch R. and Cohen J.). Thus, the Radiesse filler is one of the few drugs that actually stimulates neocollagenogenesis. At the same time, calcium and phosphate ions formed during the destruction of microspheres do not have antigenic properties, i.e. the drug is completely immunologically inert.
Another point is also very interesting: the organism sometimes responds to the introduction of any types of fillers in the formation of granulomas in soft tissues, perceiving them as a foreign object, which is a frequent complication when using dermal fillers. An interesting point is that after the injection of Radiesse granulomas are never formed. Indications for use Radiesse - correction of nasolabial folds, cheekbones, hollow cheeks, puppet wrinkles. The average duration of the effect is from 9 to 18 months, and unlike Sculptra (see below), the effect of smoothing wrinkles will be visible immediately after the procedure.
→ The price of Radiesse in clinics is from 16,000 rubles for 0.8 ml, and from 25,000 rubles for 1.5 ml.
Filler Sculptra (based on poly-L-lactic acid) -
Filler Sculptra (Sculptra) is a synthetic, biologically compatible, immunologically inert polypeptide, which consists of microspherical particles of poly-L-lactic acid. Many experts call this filler skin stimulator, because It is not a traditional dermal filler - unlike traditional fillers based on hyaluronic acid or collagen. Its mechanism of action is to initiate the formation of new collagen in the dermis, due to which there is a slow correction of deep wrinkles and the restoration of soft tissue.
The drug is produced by the international dermatological company Galderma®.
The mechanism of action of the drug is such that when properly administered, it not only corrects the depth of the wrinkle, but also restores the volume of collagen lost in the injection area. In fact, it is more like the introduction of adipose tissue in the correction of sunken areas of the face and deep folds, which occur as a result of a decrease in the volume of deeper structures (dermis and subcutaneous fat). In the correction area, you need to enter small and accurate volumes of Sculptra, so that there is no hypercorrection. Patients 30-39 years old usually use 2-3 cm3 drug, in 40-49 years - 4 cm3, older - 5 cm3.
The cosmetic effect after administration does not appear immediately, but not earlier than after 4 weeks. Sculptra injections are performed monthly (or rather, with an interval of 4-6 weeks) until the patient is satisfied with the volume of correction of the problem area. Therefore, it is impossible to immediately say exactly what amount of the drug you need, but usually it is 3-4 courses of injections. The effect is best achieved in pre-and post-menopausal women who receive hormone replacement therapy. A worse effect occurs in postmenopausal women who do NOT receive hormone replacement therapy. Studies have shown that cosmetic defects in men when using Sculptra undergo correction more quickly than women (for an unknown reason).
If it is important for the patient to immediately achieve a cosmetic effect, then Sculptra can be combined with other fillers (and already during the first visit), however Sculptra must be introduced first. It is successfully used to increase the volume of cheekbones, cheeks, correction of nasolabial folds, and the achieved results are saved for at least 18-24 months. Very important: the technique of working with this drug is very difficult, and the doctor must undergo special training, which is conducted by the manufacturer of this drug (you must ask the doctor to present such a certificate). But the effect of this drug will be the most impressive, as after a successful plastic surgery.
→ Price Sculptra - from 20-30 thousand rubles for 5.0 ml.
Facial fillers: SUMMARY
We hope that now it has become clear to you what face fillers are, and for your convenience, we will group them below into specific areas of application. Many of them have approval FDA (US Federal Bureau of Drug Quality Control). Despite the fact that FDA recommendations are always a guarantee of safety and efficacy, in some cases the lack of recommendations speaks not about the poor quality of the drug, but about bureaucratization and slow decision-making. Most often, the FDA gives its permission only 10-15 years after the appearance of a new drug (even despite the presence of a sufficient amount of clinical studies).
1. Fillers on the lips -
A very important point for choosing a filler in the lips is that increasing the volume of the body of the lips and creating a clearer contour of the red border of the lips (in the form of the “Snow White line” or “Cupid's bow”) may not be optimal using different versions of fillers. To create the contours of the red border, slightly more dense fillers can be used than to add volume to the body of the lips. In Table 1 below, you will find a list of drugs that are suitable for this purpose.
It is very important not to use too dense fillers (such as Juvederm Ultra 3 or 4) for lip augmentation, despite the fact that the duration of their effect will be longer. This is due to the fact that the lips can lose their natural elasticity, and patients can also feel in this case more dense inclusions inside the body of the lips.
2. Fillers in cheekbones recommended by the FDA -
Fillers in the cheekbones or to increase the volume of the cheeks should have an average density and elasticity. Too soft fillers are completely unsuitable for this area, and too dense you will feel like a foreign body. The FDA recommends using Juvederm, Radiesse, Sculptra, etc. to correct the cheekbones with fillers. Some products, although they do not have FDA recommendations (for example, Restylane Sub-Q or Uviderm Volume) - were created specifically for this face zone. They hold volume well, and the result can be noticeable up to 2 years.
3. Nasolabial folds recommended by FDA -
Nasolabial folds fillers (patients often call them nasolab fillers) must also have medium or high gel density, as well as low elasticity. For these purposes, the FDA approved a large number of drugs - Restylane, Juvederm, Belotero, Sculptra, Radiesse, ArteFill, and others. Specific options for different brand fillers are listed in Table 1 below.
Despite the apparent ease of use of fillers in the nasolabial folds - reviews will depend not only on the correct brand of the drug, but also on the treatment strategy. If the patient has pronounced nasolabial folds, the doctor can choose between two treatment strategies: firstly, you can correct the nasal folds themselves, and secondly, enter the filler in the cheekbones and cheeks, thereby tightening the skin back and folds .
When treating patients with large, round cheeks, it is preferable to choose the correction of the nasolabial folds themselves. And when treating patients with sunken cheeks and a small amount of tissue in the cheekbone area, it is better to introduce a filler in the cheek and cheek area (in such patients, this will allow for a better aesthetic result).
4. Fillers for eyes recommended by the FDA -
No filler has yet been approved by the FDA for use in the eye area. However, this does not mean that the fillers used under the eyes are dangerous and the reviews of cosmetologists and patients confirm this in every possible way. As we said above, the lack of FDA recommendations does not mean that there are not enough clinical studies on the drug or it has bad reviews. For the area around